Tension headache
Tension-type headache; Episodic tension-type headache; Muscle contraction headache; Headache - benign; Headache - tension; Chronic headaches - tension; Rebound headaches - tension
A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.
Headaches are usually caused by either muscle tension, vascular problems, or both. Migraines are vascular in origin, and may be preceded by visual disturbances, loss of peripheral vision, and fatigue. Most headaches can be relieved or ameliorated by over-the-counter pain medications.
The most common cause of tension-type headaches is muscle contraction in the head, neck or shoulders.
Causes
Tension headaches occur when neck and scalp muscles become tense or contract. The muscle contractions can be a response to stress, depression, head injury, or anxiety.
They may occur at any age, but are most common in adults and older teens. They are slightly more common in women and tends to run in families.
Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Activities may include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.
Other triggers of tension headaches include:
- Physical or emotional stress
- Alcohol use
- Caffeine (too much or withdrawal)
- Colds, the flu, or a sinus infection
- Dental problems such as jaw clenching or teeth grinding
- Eye strain
- Excessive smoking
- Fatigue or overexertion
Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.
Do you often feel pain or discomfort in your head, scalp, or neck? Do your muscles get tight in these areas? If the answer is yes, you may suffer from tension headaches. Tension headaches are one of the most common forms of headaches. You can get them at any age, but they mostly happen in adults and adolescents. Tension headaches occur when your neck and scalp muscles get tense, or contract. These muscle contractions can typically be a response to stress, depression, a head injury, or anxiety. Often, you can get a tension headache when you hold your head in one position for a long time without moving it. Prime examples are typing at a computer, doing fine work with your hands, and using a microscope. You can even get a tension headache from sleeping in a cold room, from a cold, from drinking too much alcohol or caffeine, or from dental problems. If you have tension headaches, you'd probably describe your pain as being Dull, pressure-like and not throbbing. You may say it feels like a tight band or vice around your head. It may be all over, not just in one point or on one side of your head or it could be worse in your scalp, temples, or the back of your head, and maybe even your shoulders. Your doctor will ask you about what may be triggering your headaches. In fact, it's a good idea to keep a diary when you get headaches, and take it with you when you see your doctor. When you get a headache, write down the day and time the pain began. Include notes about what you ate and drank in the previous 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. Write down how long the headache lasted, and what made it stop. For some people, taking hot or cold showers or baths may relieve a headache. You may need to make lifestyle changes if you have a lot of tension headaches. For example, you made need to change your sleep habits, usually you'll need more sleep, get more exercise, and stretch your neck and back muscles. Your doctor may tell you to take over-the-counter painkillers, such as aspirin, ibuprofen, or acetaminophen if relaxation techniques do not work. If you plan to do something you KNOW will trigger a headache, taking one of these painkillers beforehand may help. Your doctor MAY prescribe narcotic pain relievers, muscle relaxants, or other medicines, but after a while you may start getting rebound headaches BECAUSE you are taking medicines. The best thing you can do if you get a lot of tension headaches is to lower your stress level, and the tension level in your head, neck, and shoulder muscles. Take breaks at the computer, learn to relax, avoid stressful situations, and make quiet time for yourself.
Symptoms
The headache pain may be described as:
- Dull, pressure-like (not throbbing)
- A tight band or vise on or around the head
- All over (not just in one point or one side)
- Worse in the scalp, temples, or back of the neck, and possibly in the shoulders
The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.
You may have difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.
People with tension headaches often try to relieve pain by massaging their scalp, temples, or the bottom of the neck.
Exams and Tests
If your headache is mild to moderate, without other symptoms, and responds to home treatment within a few hours, you may not need to seek medical attention or have further examination or testing.
With a tension headache, there are usually no problems with the nervous system. But tender points (trigger points) in the muscles are often found in the neck and shoulder areas.
Treatment
The goal is to treat your headache symptoms right away and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:
- Keeping a headache diary to help you identify your headache triggers so that you and your health care provider can make changes in your lifestyle to reduce the number of headaches you get
- Learning what to do to relieve a headache when it starts
- Learning how to take your headache medicines the correct way
Many people can treat their tension headaches with conservative therapy, such as relaxation or stress-management training, including:
- Massage
- Biofeedback
- Cognitive behavioral feedback
- Acupuncture
- Ice or hot packs
When needed, medicines that may relieve a tension headache include:
- Over-the-counter (OTC) pain medicines, such as aspirin, ibuprofen, or acetaminophen
- Narcotic pain relievers are generally not recommended
- Muscle relaxers
- Tricyclic antidepressants or certain anti-seizure medicines to prevent recurrences
Be aware that:
- Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
- Taking too much acetaminophen can damage your liver.
- Too much ibuprofen or aspirin can irritate your stomach or damage your kidneys.
If these medicines do not help, talk to your provider about prescription medicines.
Outlook (Prognosis)
Tension headaches often respond well to treatment. But if the headaches are long-term (chronic), they can interfere with life and work.
When to Contact a Medical Professional
Call 911 or the local emergency number if:
- You are experiencing "the worst headache of your life."
- You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.
- The headache starts very suddenly.
- The headache occurs with repeated vomiting.
- You have a high fever or stiff neck with your headache.
Schedule an appointment or contact your provider if:
- Your headache patterns or pain change.
- Treatments that once worked are no longer helpful.
- You have side effects from medicines, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst.
- You are pregnant or could become pregnant. Some medicines should not be taken when pregnant.
- You need to take pain medicines more than 3 days a week.
- Your headaches are more severe when lying down.
Prevention
Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache.
Tips to prevent tension headaches:
- Keep warm if the headache is associated with cold.
- Use a different pillow or change sleeping positions.
- Practice good posture when reading, working, or doing other activities.
- Exercise the neck and shoulders frequently when working on computers or doing other close work.
- Get plenty of sleep and rest.
Massaging sore muscles may also help.
References
Digre KB. Headaches and other head pain. In: Goldman L, Cooney K, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 367.
Garza I, Robertson CE, Smith JH, Whealy MA. Headache and other craniofacial pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 102.
Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.
Version Info
Last reviewed on: 12/31/2023
Reviewed by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
